8/21/2023: I wrestled with selecting a fair rating (and revised it on 8/24).
Horizon Hospice services were timely and utterly SUPERB up until I needed assistance from the on-call nurse 5 hours immediately preceding death.
I no longer believe that hospice ensures a kind death. My loved one's suffering has ended. But, the experience of her dying process will haunt me for as long as I live. It only takes one hospice employee to gravely fail a dying patient.
My loved one had lost her ability to swallow at 8 pm, while still responsive. All medications were oral. At midnight, my loved one began uttering loud, high-pitched groans with intermittent screeching and grimacing. After observing for 10 minutes, I called the on-call nurse, who called back immediately. I am a retired health care provider and I know that oral pain medication is poorly absorbed through the lining of the mouth. The nurse acknowledged this and advised me to continue the oral meds at a higher dose, to raise the head of the bed (which was at maximum height), and to reposition her (she had recent pelvic and sacral fractures and cried out louder when I attempted to move her). The nurse offered no other management options, did not instruct me to call back if the behaviors persisted, and did not call back to see how she was doing. I continued to give the oral medications as instructed, but they pooled at the back of her throat with gurgling.
The screeching and grimacing continued for an hour, at which point she became obtunded.
When the on-call nurse arrived to pronounce her, I said that no one should have to die a miserable death while enrolled in hospice. I played an audiotape of the loud groans and high-pitched screeches. The nurse said she wished I had called again, as she could have inserted a rectal catheter. But, she didn't tell me that this was an option when I called for help and did not offer any other management options. Quite frankly, she should have inserted the catheter when I called, as we both knew that increasing the dose of a poorly absorbed medication would do little to no good.
I said that process improvement was mandatory, as patients often lose their ability to swallow toward the very end of life, and I asked for follow-up then and when the bereavement counselor, Christian, called a few weeks later. He said that Amy Chen or Amanda Dean would call me. No one has contacted me.
8/24/2023 Update: I revised my 8/21 rating from 3 stars to 4 stars. Heather called me this morning after reading my review. She told me that Amanda attempted to contact me, but there was an issue with my voicemail and she was unable to leave a message. We discussed the events and my concerns and she committed to ensuring that all staff were aware of best practices so that this scenario will not recur.
I believe that Horizon staff are compassionate and caring. It takes a special person to work in hospice. Of all the people involved in providing services, only one could have made a more desirable choice. Quite honestly, I will never know my loved one's level of awareness at the time she appeared to be in distress. I remain grateful to all. read more
